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* 1. Please indicate your title/role (check all that apply):

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* 2. Please indicate the race/ethnicity with which you identify (check all that apply):

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* 3. Please indicate the gender with which you identify.

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* 4. Please indicate the sexual orientation with which you identify.

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* 5. In what region of the country do you work?

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* 6. What is your perception of ACDIS as an organization, with regard to racial diversity?

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* 7. What is your perception of the CDI profession, with regard to racial diversity?

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* 8. What is your perception of ACDIS as an organization and its values of racial diversity?

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* 9. What is your perception of CDI as a profession and its values of racial diversity?

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* 10. How diverse is the organization in which you work?

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* 11. How diverse is the CDI department in which you work?

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* 12. How active is the organization in which you work in promoting diversity and inclusion?

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* 13. Do you identify as being in a racial minority?

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* 14. How well do you feel your race/ethnicity is represented by ACDIS as an organization?

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* 15. How well do you feel your race/ethnicity is represented in CDI as a profession?

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* 16. Have you experienced racial/ethnic bias in your CDI career?

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* 17. Do you believe that racial/ethnic bias has hindered your CDI career?

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* 18. Have you experienced racial/ethnic bias, at an ACDIS event or program?

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* 19. Did you immigrate to the United States?

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* 20. What steps would you recommend ACDIS take to ensure it is racially/ethnically diverse and welcoming?

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* 21. Are you willing to share your personal story as a person of color in an ACDIS publication (Journal article, ACDIS Podcast, or other)?

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* 22. If you answered yes to the previous question, or if you would like, please provide your contact information (this is optional and you may remain anonymous if preferred, or place "N/A" in any fields you do not wish to include).

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